The Medi-Cal Program: An Overview

Medi-Cal Explained

Margaret Tatar, Health Management Associates
Health Management Associates
Athena Chapman
Chapman Consulting


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Medi-Cal Explained

This publication is part of CHCF’s Medi-Cal Explained series. The series provides an overview of the program, including the people it serves, the services it provides, and how it is organized, managed, and financed.

Medi-Cal is the primary source of health insurance for more than 13 million people in California — a third of the state’s population. The program provides health coverage for children and their parents with low incomes, pregnant women, seniors, and nonelderly adults, including people with disabilities. For seniors with low incomes, Medi-Cal also covers services not paid for by Medicare, including nursing home care.

This publication is geared toward those who need a high-level understanding of the program, or those who are looking for a refresher. Topics include:

  • Who is served by the program?
  • What is the application process?
  • How are enrollees covered?
  • What benefits and services are covered?
  • What is Medi-Cal managed care? What services are carved out? How is payment structured?
  • Which agencies provide oversight for the program?
  • How is the program’s performance measured?
  • How is the program financed?
  • What role do waivers serve in the program?
  • What pilot programs exist under Medi-Cal?
  • What issues will face the program in the future?